Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

Thursday, February 09, 2017

The executive order by President Trump that temporarily banned immigration from seven predominantly Muslim countries provoked health care professionals and trainees to challenge another health care leader whom had not been so challenged previously.

We recently described how professionals and trainees protested the decision by Cleveland Clinic CEO Toby Cosgrove not to cancel a fund raising event a Mar a Lago, the resort owned by President Trump, even though Mr Trump's ban had resulted in the deportation (since reversed) of a Cleveland Clinic physician trainee, and Cleveland Clinic health care professionals and trainees had challenged the decision to continue with the event (look here). Stories about major conflicts of interest affecting Dr Cosgrove had failed to inspire any protests, or even any real public discussion.

The Dana -Farber Cancer Institute and the Immigration Ban

Now a similar story is playing out at the Dana-Farber Cancer Institute, a major academic medical institution and a prominent affiliate of Harvard Medical School.

Hundreds of medical students, doctors, and other medical personnel opposed to President Trump’s immigration order are urging the Dana-Farber Cancer Institute to cancel a lavish fund-raiser at Trump’s Mar-a-Lago Club in Florida.

But even as the number of signatures on a circulating petition grew — rising to 1,206 caregivers in Boston and across the United States by 9:20 a.m. Wednesday — Dana-Farber said it would not risk losing money earmarked for cancer research and treatment by canceling the fund-raiser.

Donors are paying as much as $100,000 to attend the fund-raiser on Feb. 18 at the 20-acre seaside resort in Palm Beach. Dana-Farber raised $2.2 million at last year’s Mar-a-Lago gala, which featured a concert by James Taylor, according to a video on the hospital’s website.

The objections to the fund-raiser are an example of the fallout over Trump’s order restricting travel from seven Muslim-majority countries — restrictions that have prompted protests across the country.

Six medical students and one doctor e-mailed a letter Sunday to Dana-Farber president Dr. Laurie Glimcher and development head Susan Paresky. They said Trump’s immigration order threatens the medical school’s research program, poses a risk to overseas patients who need cancer treatment at Dana-Farber, and 'is a direct threat to the health and well-being of thousands of refugees worldwide who are fleeing violence and persecution.'

Two Iranian medical researchers headed for Brigham and Women’s Hospital were barred from entering the country after the ban went into effect. And the medical school’s teaching hospitals are scrambling to determine whether patients from the seven targeted countries will be able to keep appointments for medical care. When the group did not get a reply to their letter, they began circulating a petition on social media at 6 p.m. Monday, said organizer George Karandinos, a Harvard medical and doctoral student.

'Given the events of recent days,' he said, 'we are asking Dana-Farber to take some moral leadership on this.'

The response was that it was too late to cancel the event. Although CEO Glimcher and Josh Beckstein, the Chair of the Dana-Farber board of trustees, said they sympathized with the petitioners' concerns, they asserted:

contracts have been signed, and a large number of people have committed to attend. Cancelling the event outright would only deny much-needed resources for research and care

Dana-Farber, which brands itself as a pioneering, trailblazing institution, closed its public statement with the argument that 'Other organizations find themselves in a similar position this year and have made a similar decision.'

Meanwhile, the protesters thought the Institute could have done better:

'This was covered in the press as an issue in September,' said George Karandinos, a Harvard medical student among those leading the backlash. 'Partially because this has been brought up before, we're less sympathetic to the argument that the fundraiser is so close' In light of the fact that President Trump has 'sent out a message of exclusion, discrimination, and hate,' Karandinos said, this response 'felt very weak.'

And the number of signatures on the petition continues to rise. It is now greater than 2000. It is likely the protests will get stronger:

Because Dana-Farber has opted to proceed with the Mar-a-Lago gala—has not committed to distancing itself from the Trump Organization in the future—the Harvard students, doctors, and patients are elevating the stakes. This coming Saturday, they plan to rally on the quad of Harvard Medical School, in the shadow of the cancer institute. In the spirit of evidence-based effective protest, their request is clear and concrete: 'We call on the Dana-Farber to relocate its fundraiser away from President Trump’s Mar-a-Lago this year and in all subsequent years.'

Maybe it should have been no surprise that Dr Glimcher was not sympathetic to arguments that the Mar a Lago fund raising event posed a conflict of interest for the Dana-Farber, notwithstanding the conflicts of interest created for President Trump by his continuing business ownership. Dr Glimcher actually has a long history of her own conflicts of interest.

Dr Glimcher's Conflicts of Interest

As in the case of the Cleveland Clinic, the strong response to Dr Glimcher's refusal to cancel the Mar a Lago fundraiser could be contrasted with the lack of response to what could have been considered questionable actions by Dr Glimcher in the past. Dr Glimcher accepted leadership positions at the Dana -Farber, and before then at Weill Cornell Medical School, despite severe conflicts of interest.

As we noted in 2011, at the time Dr Glimcher left Harvard to become Dean of the Weill Cornell Medical School, she was already the longest serving member of the board of directors of pharmaceutical giant Bristol-Myers-Squibb. At that time, she was paid over $240,000 a year for her services on the board, and owned more than $1.4 million of BMS stock units.

At that time, Dr Glimcher was also on the board of directors of the Waters
Corporation, which makes laboratory equipment used in pharmaceutical
research.

A long time ago, in 2006, we first blogged about a "new species of conflict of interest" which we thought
might prove to be even more important than other conflicts of interest
afflicting health care that were then starting to be discussed. This
new species involved health care organizational leaders who were
simultaneously members of the boards of directors of for-profit health
care corporations. We posited these conflicts would be particularly
important because being on the board of directors entails not just a
financial incentive. It ostensibly requires board members
to "demonstrate unyielding loyalty to the company's shareholders" [Per
Monks RAG, Minow N. Corporate Governance,
3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.] Thus,
for example, the conflict posed by the president of a university, to
whom a medical school and academic medical center report, who also is
the director of a pharmaceutical company, would be extreme.

Furthermore, even in 2011, BMS had a track record that included settling allegations that the company gave kickbacks to physicians to promote its products. These actions would have been taken place while Dr Glimcher was responsible for the governance of the company.

At that time, appointing a member of the boards of Bristol Myers Squibb and Waters Corporation to be dean of Weill Cornell Medical School incited no public discussion, much less protest. I know of no more public discussion or protest ensuing after Dr Glimcher became CEO of Dana-Farber.

Furthermore, Bristol-Myers-Squibb has continued its ethical misadventures under Dr Glimcher's watch. Last year we discussed yet another settlement it made of allegations of giving kickbacks to doctors to induce them to prescribe its medication. Prior to that, but still on Dr Glimcher's watch, we noted the following:

- In 2003, for $617 million, BMS settled suits alleging it tried to
prevent competition from low cost generic versions of its products Taxol
and Buspar (per the NY Times).
- In 2004, for $150 million, BMS settled suits by the SEC alleging accounting fraud (per the NY Times here).
- In 2007, BMS paid a $1 million dollar penalty while pleading guilty to
lying to federal agents about a deal with the Canadian drug company
Apotex (per Law360). In 2009, it paid additional financial penalties in response to a US Federal Trade Commission charge about this case (per the FTC).
- In 2007, for $515 million, BMS settled a suit alleging it used
kickbacks to induce use of Abilify for dementia and by childeren,
despite evidence that the drug was not suitable for either. The
settlement included a five year corporate integrity agreement. (Look at
our post here).
- In 2014, BMS settled allegations its subsidiary Lantheus Medical Imaging Inc evaded state taxes (per the Corporate Crime Reporter)
- In 2015, Bristol-Myers-Squibb settled allegations by the US Securities
and Exchange Commission (SEC) that it bribed physicians in China to
induce them to prescribe its drugs. (Look at our post here).

Maybe those who protest Dr Glimcher's current actions will note that these actions were presaged by her publicly known but largely ignored past actions.

Summary

Donald Trump's campaign, his election, and the beginnings of his administration have evoked tremendous controversy. Of many questions raised, those about his voluminous conflicts of interest, and whether has background as a corporate leader is suitable for leadership in other spheres, particularly the political, have been salient. One unanticipated effect of his early decisions as president seems to be to raise questions about his relationships with leaders in other spheres with their own conflicts, and own doubtful qualifications for their leadership roles.

It is ironic that Mr Trump has pledged to stand up for working people and the middle class, while his affinities seem to be almost entirely for the rich and conflicted.

Dr Toby Cosgrove of the Cleveland Clinic and Dr Laurie Glimcher of the Dana-Farber Cancer Institute seem relatively untroubled about their institutions' financial arrangements with Mr Trump's ongoing businesses, despite the conflicts that these businesses pose for a sitting president. Furthermore, both Dr Cosgrove and Dr Glimcher have had and continue to have major conflicts of interest affecting their own leadership positions, conflicts which have been largely anechoic up until now.

The protests of President' Trump's dubious actions may shed needed light on the large, complicated network of insiders which has disproportionate influence on health care, public policy, and politics.

So here goes again, for the umpteenth time...

I now believe that the most important cause of US health care
dysfunction, and likely of global health care dysfunction, are the
problems in leadership and governance we have often summarized
(leadership that is ill-informed, ignorant or hostile to the health care mission and professional values, incompetent, self-interested, conflicted or outright criminal or corrupt,
and governance that lacks accountability, transparency, honesty, and
ethics.) In turn, it appears that these problems have been generated by
the twin plagues of managerialism (generic management, the manager's coup d'etat) and neoliberalism
(market fundamentalism, economism) as applied to health care. It may
be the many of the larger problems in US and global society also can be
traced back to these sources.

We now see our problems in health care as part of a much larger whole,
which partly explains why efforts to address specific health care
problems country by country have been near futile. We are up against
something much larger than what we thought when we started Health Care Renewal in 2005. But at least we should now be able join our efforts to those in other countries and in other sectors.

True health care reform would restore health care leadership that
understands health care and medicine, upholds the health care mission,
is accountable for its actions, and is transparent, ethical and honest.

All our bloggers have their own political views. We are non-partisan in that we will not recommend a party or any particular candidate. I think you can look at our history and see we have been equal opportunity offenders of politicians, calling out politicians and government officials for their conduct when we thought it was appropriate to do so (even occasionally those people were not in the US). Those were our opinions, of course, and anyone can differ with us. So we have made implied or direct criticisms of presidents and their policies before. And we think no president, and no politician or government official to be immune from criticism. But it is up to our readers to vote for whom they choose.

If someone considers it partisan to be against corruption and bigotry then than suggests that person approves of corruption and bigotry. This is not an 8th grade lunch table where criticizing the leader of one political party for actions which demonstrate immoral ethics implies a support of another party. Criticism of Trump is based on his actions. That is not partisan as no support of the other side is stated or implied.

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